Cardiovascular drugs Flashcards
ACE inhibitors examples
ramipril, lisinopril
Main indications for ACE inhibitors
Hypertension- first line, heart failure, secondary prevention after MI
What do ACE inhibitors do
ACE inhibitors competitively inhibit angiotensin converting enzyme (ACE) and thus reduce the generation of angiotensin II and also consequently aldosterone. reduces sodium and water retention and leads to arterial and venous dilation
contraindications and cautions of ACE inhibitors
afro-caribbeans dont respond well- CCBs first line instead
May lower blood glucose in diabetes
Contraindicated in pregnancy
Be careful in combination with other drugs that can increase potassium eg thiazide like diuretics and potassium sparing diuretics
Adverse effects of ACE inhibitors
persistent dry cough, renal dysfunction, angioedema
Amiodarone main indications
arrhythmias particularly when other drugs are ineffective or contraindicated
Mechanism of action of amiodarone
Anti arrhythmic and anti adrenergic. blocks potassium channels so lengthens refractory period, blocks sodium, blocks alpha and beta receptors, weak calcium blocking effect, slows sinus rate and AV conduction and slightly prolongs QT interval
Contraindications of amiodarone
heart block, bradycardia, thyroid dysfunction, hypokalaemia, cardiomyopathy, congestive heart failure, severe resp or heart failure
adverse effects of amiodarone
corneal microdeposits, hypokalaemia, hepatic disorders, hyperthyroidism, resp disorders, phototoxic
Atropine indications
bradycardia
mechanism of action of atropine
binds to and inhibits muscarinic acetylcholine receptors, producing anticholinergic effects
contraindications of atropine
HF, coronary artery disease, hypertension, hyperthyroidism, tachycardia, arrhythmias, acute MI, GI obstruction
adverse effects of atropine
dry mouth, dizziness, blurred vision, nausea
aspirin main indications
ACS, ischaemic stroke, thromboprophylaxis in patients in high cardiovascular risk
aspirin mechanism of action
main antiplatelet, irreversibly blocks COX in platelets which inhibits TXA2 synthesis and production of antithrombotic prostaglandin I2 PGI2
contraindications of aspirin
avoid in active peptic ulceration and bleeding disorders
adverse effects of aspirin
GI bleeding and ulceration
Angiotensin receptor blockers ARBs examples
iosartan, valsartan
main indications of ARBs
hypertension, post MI, heart failure - when ACEi not tolerated
mechanism of action of ARBs
competitively inhibits the binding of angiotensin II to AT1 in many tissues including vascular smooth muscle and adrenal glands. causes vasodilation and blockage of aldosterone release
contraindications of ARBs
pregnancy, planning to be pregnant
adverse reactions to ARBs
dizziness (postural hypertension), hyperkalaemia, localised angioedema
alpha blockers main indications
resistant hypertension
alpha blockers example
doxazosin
beta blockers- cardioselective examples
atenolol, bisoprolol
beta blockers- non cardioselective examples
propranolol, carvedilol
cardioselective beta blockers main indications and mechanism of action
competitive inhibition of only B1 receptors, used in angina, ACS, MI, hypertension, heart failure. lowers heart rate and blood pressure
non-cardioselective beta blockers main indications and mechanism of action
block beta 1 and beta 2 receptors. used in thyrotoxicosis, migraine. lowers the HR and BP
contraindications and cautions of B Blockers
brittle asthma, can worsen HF in the short term
adverse effects of B blockers
tiredness, cold peripheries
calcium channel blockers examples
amlodipine, verapamil, diltiazem
mechanism of action of Ca channel blockers
interfere with inward displacement of ca ions through the slow channels of active cell membranes
main indications of calcium channel blockers
hypertension, angina, supraventricular arrhythmias (AF, SVT- slows HR)
contraindications of CCBs
should not be administered to patients being treated with a B blocker because they also depress cardiac electrical and mechanical activity and therefore addition of CCB augments the effects and cause heart block or bradycardia
side effects of CCBs
dizziness, flushing, headache, nausea, ankle oedema
types of antiplatelet medications
clopidogrel, ticagrelor, aspirin
clopidogrel main indications
thromboprophylaxis in patients intolerant to aspirin, ACS when combined with aspirin has a synergistic action
mechanism of action of clopidogrel
inhibits P2Y12 receptors (stops ADP binding)
contraindications and cautions of clopidogrel
patients at increased risk of bleeding
adverse effects of clopidogrel
GI bleeding and ulceration
digoxin main indications
heart failure, arrhythmia, hypertension (4th line)
mechanism of action of digoxin
inhibits Na-K-ATPase membrane pump resulting in increase in intracellular sodium and calcium increasing contraction of muscles and reducing conduction of AV node. given IV
contraindications of digoxin
narrow therapeutic index- too much can cause AV delay to be too long and cause bradycardia and heart block, increases ventricular irritability which produces ventricular arrhythmias
side effects of digoxin
heart block, arrhythmias, diarrhoea, overdose- yellow vision, headache, nausea, vomiting
diuretics main indications
used to treat hypertension (thiazide like diuretics) and heart failure (loop diuretics)
examples of loop diuretics
furosemide, bumetanide, ethacrynic acid, torasemide (PO or IV)
examples of thiazide like diuretics
furosemide, bendrofluazide, chlorothiazide (PO)
mechanism of action of diuretics
block sodium reabsorption in kidneys
contraindications of diuretics
use with caution in renal dysfunction
side effects of diuretics
hypokalaemia- tiredness and arrythmia, hyperglycaemia- diabetes, increased uric acid, gout, impotence in men
direct oral anticoagulants (DOACs) main indications
prevention of DVT in hip or knee replacements, DVT and PE
direct oral anticoagulants (DOACs) mechanism of action
direct inhibitors of thrombin or factor Xa (PO)
examples of DOACs
dabigatran, rivaroxaban, apixaban, edoxaban
spironolactone
potassium sparing diuretic that prevents reabsorption of sodium and keeps potassium levels from getting too low, side effects- dizziness and light headedness
contraindications of DOACs
no specific agent available to reduce haemorrhage in overdose but predictable degree of anticoagulation so minimal risk
adverse effects of DOACs
bleeding (less common than in warfarin or heparin)
heparin main indications
DVT, PE, unstable angina
heparin mechanism of action
neutralises active clotting factors (IV or subcutaneous)
heparin side effects
haemorrhage, heparin induced thrombocytopenia, hyperkalaemia
ivabradine
used in angina and heart failure. slowing heart rate in sinus rhythm (doesnt work in AF), can cause visual disturbances, PO, channel modulator
low molecular weight heparins main indications
generally preferred ovr heparins. used in DVT, PE, unstable angina (SC)
contraindications of LMWHs
renal failure- use heparin instead as it is not excreted via the kidneys
Neprilysin inhibitors examples
sacubitril/valsartan
main indications of neprilysin inhibitors
heart failure (PO)
mechanism of action of neprilysin inhibitors
stop neprilysin from breaking down natriuretic peptides,. NPs cause vasodilation and decrease sympathetic tone so more NPs mean more vasodilation
contraindications of neprilysin inhibitors
do not use alongside ACEi or ARBs
side effects of neprilysin inhibitors
hypotension, renal impairment, hyperkalaemia, angioneurotic oedema
nitrates examples
isosorbide mononitrate
main indications for nitrates
angina- GTN, acute HF. (sublingual, IV)
mechanism of action of nitrates
relax all types of smooth muscle via metabolism to nitric oxide
adverse effects of nitrates
headaches, hypotension, collapse
statins examples
simvastatin, atorvastatin
main indications of statins
drug of choice to reduce LDLs. hypercholesterolaemia- prevention of heart attack and stroke, diabetes, angina (PO)
mechanism of action of statins
act as competitive inhibitors of HMG-CoA reductase. decreases inflammation, reversal of endothelial dysfunction, decreased thrombosis, stabilisation of atherosclerotic plaques
contraindications of statins
elderly, high alcohol intake, history of liver disease, hypothyroidism, avoid in pregnancy
adverse effects of statins
myopathy, rhadbomyolysis
streptokinase used for
reduces mortality on acute MI (IV)
warfarin
prevents blood clots. used for people with mechanical heart valves